Statistically speaking, we declare anyone with repeated blood pressure readings of less than 120/80mm Hg as normal. We also diagnose patients' whose blood pressure is regularly greater than 140mg Hg (systolic or top number) or 90mm Hg (diastolic or bottom number) w/hypertension and start prescribing them medicine(s). But what about that vast chasm in between where patients have blood pressures of 120-139/80-89mm Hg? We talk to these patients about TLC or therapeutic lifestyle changes, you know, more fruits & veggies, less sodium, more exercise, etc.

While there continues to be great debate as to what to do about blood pressures above normal, repeated studies have demonstrated that the risk of stroke, heart disease & cardiovascular mortality doubles w/each 20/10mm Hg increase over 115/75mm Hg. Yet, our clinical inertia is such that we appear to need more evidence before we become more aggressive about our blood pressure lowering goals. I suppose we can thank ACCORD (Action to Control Cardiovascular Risk in Diabetes) as noted last Thursday. But there is danger in taking one study of a specific (diabetic) population and applying it to the (non-diabetic) general population.

So to lend credence to the aforementioned increase risk for stroke associated with pre-hypertension, the authors published online last week a meta-analysis of twelve studies (5 from Japan, 4 from the States, 2 from China & 1 from India) involving 518,520 participants followed from 3-32 years. Their conclusion? Pre-hypertension increases risk of stroke by 50%, even in the non-elderly. However, the authors should be thanked for breaking down the wide range of pre-hypertensive blood pressure into low (120-129/80-84mm Hg) and high (130-139/85-89mm Hg) groups because subanalysis of the data demonstrated that the increase risk of stroke was truly only attributable to the high end and not the low.

So perhaps we should start prescribing blood pressure lowering medications for persistent blood pressures greater than 130mm Hg or 85mm Hg. But before jumping to that conclusion (especially prior to the release of JNC8), remember that this was a meta-analysis and therefore only useful for developing hypotheses but gives no proof of cause & effect. Still, I wouldn't think twice about seeing patients more often in order to convince them of the importance of lower blood pressures.

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How many times should a normal male have sex. And how often does a normal female have intercourse?

I composed my answer at www.avvo.com but apparently I missed the deadline (?) so I've copied & pasted it below:

There truly isn't a normal frequency of sexual intercourse for men or women. What's normal for you may be either abnormally high or low for someone else as the range for normal is quite wide. It's not the best analogy but think about the frequency of bowel movements. Again, there isn't a normal frequency but rather a wide range of normal such that what's a normal frequency for you may be abnormally frequent or infrequent for someone else. In fact, we don't necessarily define diarrhea & constipation by a specific number or frequency of bowel movements but rather relative to your baseline. Likewise, as long as you're satisfied (and so is your partner), then we encourage you to ignore the typical bar talk, magazine articles, and movies (both mainstream and adult-oriented).

With that said, we do know that over time, as we age, the frequency of sexual activity decreases. Some of this may be attributable to the accumulating burden of medical conditions and/or medications (which may or may not affect one's testosterone level). Our mood (depression comes to mind) can obviously affect the frequency of sexual activity. Of course, most of us tend to gain fat weight & lose physical conditioning, which doesn't help the issue. Erectile dysfunction can affect the man's confidence and thus decrease the frequency of attempted intercourse. Menopause can lead to physiologic changes in the female genitalia, which if not addressed, can lead to pain & discomfort, the exact opposite of what's desired, and thus a decrease in frequency of sexual activity. However, not every couple or person necessarily reports a decrease. Some actually report an increase in frequency, especially if they find a more compatible partner.

So rather than focus on the need to achieve a specific frequency of sexual relations in some given period of time, focus on the satisfaction of your partner (and yours should follow soon thereafter). One other thought comes to mind and that is that frequency of sexual relations might also be affected by religious & cultural upbringing as well as by mood. Basically, if you're not satisfied, talk to your family physician and get evaluated. Good luck!

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